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1. Question: A patient has been complaining of palpitations for the past week and presents to you at an urgent care clinic for evaluation. You perform a 12 lead EKG and identify atrial fibrillation with a hear rate of 122 beats per minute. What is your next order?
2. Question: Which of the following do not represent possible causes of a prothrombotic state?
3. Question: An 80-year-old man with a history of atrial fibrillation presents with sudden-onset unilateral leg pain and pallor. What is the most likely diagnosis?
4. Question: A 65-year-old woman presents for a follow-up examination. She is a smoker, and her hypertension is now adequately controlled with Her mother died at age 40 from a heart attack. The fasting lipid profile shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In addition to starting therapeutic lifestyle changes, the nurse practitioner should start the patient on:
5. Question: Your patient has been diagnosed with a 5cm ascending aortic aneurysm. Which medical imaging is considered standard of care for serial surveillance?
6. Question: Preventive cardiac care should focus primarily on addressing all the following except?
7. Question: The suggested International Normalized Ratio (INR) range in a patient being treated for atrial fibrillation is:
8. Question: While working in a fast-track clinic as a NP in an emergency department, your patient complains of shortness of breath with activity and near syncope with changing position from seated to standing on multiple recent episodes. You examine them and notice a harsh systolic murmur heard best at the right sternal border at the 2nd intercostal space rated 3/6, which has a bruit radiating to the right carotid artery. Of the following examinations, which is most appropriate or you to order next to evaluate this murmur?
9. Question: Your patient admitted with crushing chest pain just converted from sinus rhythm to sinus bradycardia and developed elevated ST segments in lead II, III, and What intervention is the priority for this patient’s care?
10. Question: As a f/u from a hospitalization an adult patent presents with ankle Which of the following medications is the most likely cause of the edema?
11. Question: A 60-year-old man presents with recurrent kidney stones, abdominal pain, and bone pain. Laboratory results show elevated serum calcium and low phosphate What is the most likely diagnosis?
12. Question: A patient has a 3 cm pituitary mass noted on What is your next step in evaluating the patient?
13. Question: Which of the following is at highest risk for type II diabetes?
14. Question: Which of the following is the most common cause of Cushing’s Syndrome?
15. Question: A 35-year-old woman with a history of hypothyroidism presents with fatigue, weight gain, constipation, and cold Her TSH level is elevated, and her free T4 is low. What is the most appropriate next step in management?
16. Question: An adult female presents with a chief complaint of fatigue and weight She states that she doesn’t feel like herself. A diagnosis of hypothyroidism is suspected. Which of the following physical findings would support this diagnosis?
17. Question: All the following are symptoms of hypocalcemia except:
18. Question: A starting dose for a elderly adult patient with a BMI of 20 needing levothryoxine
19. Question: An adult female who recently returned from a business trip to Japan presents for a recheck The only remarkable laboratory result is for thyroid-stimulating hormone (TSH), at 0.3 microunits/mL (normal = 0.4–6 microunits/mL). The patient reports that her neck hurts; examination reveals thyroid tenderness. Which of the following laboratory tests should the nurse practitioner order now?
20. Question: A patient is evaluated in the urgent care for complications of Type 2 diabetes due to an episode of recent life stressors. All the following are consistent with HHS except:
21. Question: How should a nurse practitioner evaluate if palliative care is effective?
22. Question: A 90-year-old female is brought to the clinic by her She states that everything is fine, but the nurse practitioner notes that she has poor hygiene and bruises on her trunk. The neighbor is concerned that the patient often has no money to buy food, despite income from social security and a coal miner’s pension. The nurse practitioner suspects abuse. Which of the following is the nurse practitioner obligated to do next?
23. Question: An elderly patient diagnosed with end-stage lung cancer has been refusing meals, opting instead for ice cream The family is concerned about the patient not getting enough nutrition. The NP:
24. Question: A 92-year-old presents with a decline in personal care and increasing They had a CVA a three years ago with mild cognitive changes then which has slowly progressed. The more likely diagnosis in this case is?
25. Question: A frail elderly patient presents with Which of the following normal physiologic changes seen with aging is the most likely cause?
26. Question: An adult presents with increasing abdominal The nurse practitioner suspects ascites. Which finding on physical exam would confirm the suspicion of ascites?
27. Question: A 39-year-old female is being seen by your service for diarrhea. Patient reports 3-4 loose stools a day. She also reports mild cramping. The patients stool culture was negative, her fecal occult and ESR were Which lab would be important to also test if you are suspecting IBD?
28. Question: A 70-year-old patient presents to the clinic with dyspnea, palpitations, and The patient reports a 2-week history of blackened stools, which the patient attributes to drinking berry juice. Assessment reveals vital signs of BP = 110/60, P = 100, R = 24; Hgb = 4.5 g/dL; Hct = 16%. What is the most appropriate immediate intervention?
29. Question: A 28-year-old woman presents with abdominal pain, diarrhea, and weight She also reports occasional bloody stools. Colonoscopy reveals continuous inflammation from the rectum extending proximally. What is the most likely diagnosis?
30. Question: A 29-year-old male presents with severe abdominal pain, he has a history of alcohol abuse, and recurrent Patients Lipase is elevated, and he has nausea and vomiting as well. Abdominal CT shows inflammatory changes around the pancreas. What is the most important intervention to consider in the acute phase?
31. Question: The most specific indicator of the presence of ascites is:
32. Question: A 26-year-old female presents with abdominal distention, bloating, and intermittent crampy abdominal pain relieved by She has 4 to 6 loose stools a day when stressed. Between bouts of diarrhea, she often has constipation. Physical examination results are normal. The CBC was normal. The most likely diagnosis is:
33. Question: A 38-year-old male presents to the ER with complaints of abdominal pain, intermittent diarrhea, and has a positive occult blood. A stool culture is done which does not show any organism His CRP and fecal calprotectin are elevated, and a colonoscopy is performed with biopsy which shows changes consistent with Crohn’s disease, which are mild. What of the following represent the first line of treatment for this illness?
34. Question: An adolescent with asthma presents for follow-up After several changes in medications and doses, the parents report that the adolescent continues to experience difficulty with coughing, especially at night. Which of the following conditions is most likely cause of the continued cough?
35. Question: A 43-year-old male with past medical history significant for GERD, smoking, and obesity presents to your clinic for worsening GERD symptoms, he has been taking protonix 40mg daily with no improvement. What imagining/diagnostic would be warranted for this patient.
36. Question: Which of the following is an example of implied consent?
37. Question: Evidence based health screening is utilized with an understanding of the limits of interpreting the In this context, the term sensitivity refers to the ability of a test to:
38. Question: Which act formed in 1996 was created to protect patient health information from being disclosed without the patient’s consent or knowledge?
39. Question: Which of the following risks of patient use of convenient/urgent care may increase the risk of a nurse practitioner to miss subtle changes in the patient’s condition over time?
40. Question: The nurse practitioner is caring for an acutely-ill 92 year old ICU intubated patient not responding to the best available care after a perforated gastric ulcer who underwent surgical exploration and washout two weeks ago. They have gone into ventricular tachycardia twice this morning and resuscitated with the use of DC cardioversion and IV amiodarone. Subsequent labs reveal profound lactic acidosis and they are not expected to survive the day due to a presumed diagnosis of mesenteric infarct. Before the first surgery, the patient told you and the family they did not want to undergo extreme measures to sustain their life and would like to “go out with some dignity”. Which of the following would NOT be an appropriate consult to make at this time?
41. Question: An adult patient presents with complaints of acute-onset unilateral right eye pain, visual changes, seeing halos around lights, abdominal pain, and intermittent Physical findings include an erythematous right eye without discharge, a cloudy cornea, and a moderately dilated right pupil that is non-reactive to light. The nurse practitioner should immediately:
42. Question: An adult presents complaining of “blood in my eye”. The patient noted obvious scleral bright-red blood upon awakening but reports no history of Past medical history includes anxiety, environmental allergies, and hyperlipidemia. Physical examination reveals no exudates or tearing. The patient denies visual disturbances and absence is confirmed by visual acuity testing. The most appropriate course of action is to:
43. Question: You are following up with a 24-year-old male patient who was recently in a motor vehicle collision at a high rate of A CT head is performed revealing a pyramidal fracture involving the lateral walls of the maxillary sinuses and inferior orbital rim. Which classification of fracture is this? Le Fort IV
44. Question: Which of the following is not one of the four Ds of epiglottitis?
45. Question: Patients presenting with globe rupture should be sent to immediate surgery due to which of the following reasons?
46. Question: Initial management for a patient with dry eyes should include:
47. Question: Your patient with a large bump on their cheek should be evaluated and ruled out for which cardiac complication-linked diagnosis?
48. Question: Workup to rule out cardiac source of an embolic stroke should include which of the following exams?
49. Question: Which of the following best characterizes presbycusis in the older adult?
50. Question: A patient presents with blood present in the anterior portion of their eye covering the lower half of their With which of the following diagnoses is this most consistent?
51. Question: A patient presents to the urgent care with SOB, fatigue, headache, and chest Cardiac work-up is negative but CBC reveals a hemoglobin of 6.5. Which of the following indices would indicate a potential iron deficiency anemia?
52. Question: All the following thrombocytopenic emergencies require immediate action except:
53. Question: Which of the following is appropriate long-term treatment for B12 deficiency in a patient with a history of gastric bypass?
54. Question: A patient with rheumatoid arthritis is admitted to the rehab unit you oversee for management of pain due to pelvic fracture after motor vehicle Admission labs show ANC of 1.4. The patient is asymptomatic and denies history of repeated infection. What is the most appropriate level of intervention for this patient?
55. Question: A 13 year old female who is diagnosed with iron deficiency anemia is being treated with ferrous sulfate. Proper treatment typically leads to the resolution of anemia within:
56. Question: A 35-year-old man presents with recurrent episodes of severe pain in his back, chest, and He has a history of sickle cell disease. What is the most appropriate initial management during a pain crisis?
57. Question: A patient diagnosed with iron deficiency anemia requires iron Which of the following treatments would likely be ineffective?
58. Question: In which of the following patients is PRBC transfusion recommended?
59. Question: Treatment for symptomatic aplastic anemia includes all the following except:
60. Question: Progression to Acute Myelogenous Leukemia (AML) is a risk for untreated or poorly responsive:
61. Question: Your patient has been started on sulfamethoxazole for a urinary tract infection and two days later states she feels painful blistering on her skin. Which of the following life- threatening disease states are you most concerned about?
62. Question: Which of the following treatments is not recommended for a patient with a new diagnosis of rheumatoid arthritis?
63. Question: Patients with a new diagnosis of primary progressive multiple sclerosis are most likely to benefit from treatment with which of the following agents?
64. Question: Patients with a diagnosis of myasthenia gravis are more likely to have the presence of which tissue in greater quantities?
65. Question: A patient is newly diagnosed with multiple Treatment includes prednisone with physical therapy. The nurse practitioner advises the patient to begin disease-modifying therapy:
66. Question: Your patient has been diagnosed with HIV and wants to know the goal of treatment with “all these medications”. Which of the following represents the most reasonable goal in the treatment of HIV?
67. Question: Long-term immunoglobulin that is carried from generation to generation is likely which type of immunoglobulin?
68. Question: Your patient arrives the urgent care complaining of a swollen throat and vocal Which of the following statements made by the patient brings an index of suspicion of angioedema?
69. Question: A patient who has active herpes zoster is at risk of shedding which contagious virus?
70. Question: Patients who present with a vesicular rash along a dermatome with hypersensitivity at the site before the lesion erupted are likely experiencing which illness?
71. Question: Your patient is being educated about the management of the new diagnosis of melanoma. Which of the following techniques is the most likely approach to be used in removal of the melanoma?
72. Question: What is the definitive treatment for uncomplicated skin abscess on the arm?
73. Question: A pediatric male is present with his mother, who states that he is extremely restless at night and constantly scratches his anal Which diagnostic procedure would confirm a diagnosis of pinworm infestation?
74. Question: Your patient has been noticing cracking and peeling on their hands and having some vesicular rash component. Which of the following is not likely the diagnosis?
75. Question: What is the following is not an effective strategy of treatment for verruca?
76. Question: You are admitting an otherwise healthy 67-year-old female patient with a leading diagnosis of She has a history of palmar dyshidrotic eczema who has been taking mometasone ointment for over a month. She reports stopping this medication a few days prior to admission. With this information, what is the likely diagnosis of her admission?
77. Question: Treatment of acute poison ivy includes:
78. Question: What is the etiology of verruca?
79. Question: An adult female with a diagnosis of eczema was given a prescription of hydrocortisone valerate 2% (Westcort) ointment last week for increased itching. The patient returns today reporting no improvement and more itching. The nurse practitioner’s examination finds many vesicles and papules on hands, chest, and buttocks. The nurse practitioner also finds a linear burrow between the fingers and prescribes:
80. Question: An adult daycare worker presents with severe itching on the arms and around the arms and wrists. The patient’s skin is mildly excoriated from scratching. Microscopic examination of a skin reveals The treatment of choice for the patient would be?
81. Question: Your patient has presented with an acute GI In working up potential causes, which of the following scenarios is most probable as a reason for the bleed?
82. Question: A 50-year-old woman with a history of osteoporosis presents for a routine check-up. What is the most appropriate medication to prevent further bone loss?
83. Question: Patients who present with decreased joint space of a lumbar vertebrae on x-ray are likely diagnosed with which of the following chronic disease states?
84. Question: Which of the following is a urate lowering drug that may be used in conjunction with NSAIDs in treating gouty arthritis?
85. Question: A patient has moderate Which of the following dietary supplements could be recommended to reduce pain and joint space narrowing?
86. Question: Which of the following treatments is most successful for patients with chronic fatigue syndrome?
87. Question: Which of the following behaviors is likely to elicit rhabdomyolysis?
88. Question: An 84-year-old patient presents with complaints of diffuse bilateral lower back pain which is made worse by On exam the patient maintains a posture of forward flexing at the waist. The most likely diagnosis is?
89. Question: The patient undergoing a cardiac arrest after a recent fracture should be considered for which of the following potential causes of pulseless electrical activity?
90. Question: Which of the following are not items assessed for compartment syndrome?
91. Question: Which of the following states represents an example of postrenal failure?
92. Question: What is the standard treatment for women with uncomplicated urinary tract infection in a geographical area with less than 20% resistance?
93. Question: Which portion of the renin-angiotensin-aldosterone mechanism is inhibited by lisinopril?
94. Question: A 50-year-old man presents for a routine check-up and expresses concerns about prostate What is the most appropriate screening recommendation for prostate cancer?
95. Question: Which nationality is four times as likely as Caucasians to be diagnosed with kidney disease?
96. Question: A 24-year-old female reports urinary urgency with suprapubic tenderness relieved by bladder emptying. The patient has been evaluated by urology and urogynecology. Review of laboratory reports reveal negative urinalysis and cultures, negative results for sexually transmitted infections, and an unremarkable Which of the following is an appropriate plan of care?
97. Question: A 25-year-old woman presents with a urinary tract infection (UTI) confirmed by urinalysis. She has no What is the most appropriate first-line antibiotic treatment?
98. Question: An older adult patient with chronic renal disease has been experiencing a steady decrease in glomular filtration rate over the past 3 months. Which type(s) of antihypertensive medication would be most appropriate for the patient at this time?
99. Question: Which of the following suggest a diagnosis of glomerulonephritis?
100. Question: Patients with uncontrolled hypertension should be started on antihypertensive agents in addition to diet and exercise. Which medication should not be considered for a hypertensive patient with acute kidney injury with a creatinine of 3.1?
101. Question: Which of the following visual defects is associated with loss of vision of the same side of the field in both eyes?
102. Question: Patients who exhibit a positive Kernig’s sign should be evaluated for which potential illness?
103. Question: Your patient has a new diagnosis of Parkinson’s disease and presents after one month of treatment to urgent care with acute hypotensive episode with a blood pressure of 90/44. Which medication is likely responsible for this?
104. Question: What of the following represents an abnormal level for intracranial pressure?
105. Question: Patients who present with SAIDH should be treated with which of the following regimens?
106. Question: A 37-year-old woman with a history of chronic migraines presents with unilateral headache, photophobia, and She mentions that her headaches have been progressively worsening. What is the most appropriate next step in evaluation?
107. Question: A geriatric male with trigeminal neuralgia who has a history of hypertension and depression is currently taking amlodipine besylate (Norvasc), 5 mg daily and sertraline (Zoloft), 25 mg He is allergic to penicillin and imipramine (Tofranil). The patient has been treated unsuccessfully with gabapentin (Neurotin). The drug of choice for this patient would be:
108. Question: A patient presents with left temporal-parietal headache that has been increasing in intensity and frequency over the past 2 Coughing increases the pain. Past history is non-contributory. Today, the patient began having difficulty forming words. Physical examination is normal except for some blurring of the disc margins on fundoscopic examination. The best course of action involves:
109. Question: Which of the following agents does not represent a common cause for bacterial meningitis?
110. Question: Because of the frequency and debilitating nature of an adult patient’s migraine headaches, the NP decides to place the patient on preventive therapy. Which medication would be most appropriate?
111. Question: A pediatric male is present with his mother, who states that he is extremely restless at night and constantly scratches his anal Which diagnostic procedure would confirm a diagnosis of pinworm infestation?
112. Question: A late adolescent is brought to the nurse practitioner’s office by her mother, who is concerned about her daughter’s recent weight loss and the potential of purging herself after meals. The daughter denies any self-induced vomiting, starvation or excessive activity. History reveals that the daughter was consistently in the 50th percentile for weight but is now in the 10th She does state that she jogs 5 miles a day and is in good condition. In addition to a complete blood count with differential, which of the following laboratory tests will be most helpful for further assessment?
113. Question: A late adolescent patient presents with acute-onset unilateral right eye pain, visual changes, seeing halos around lights, abdominal pain, and intermittent Physical findings include an erythematous right eye without discharge, a cloudy cornea, and a moderately dilated right pupil that is nonreactive to light. The nurse practitioner should immediately:
114. Question: A 15-year-old adolescent athlete complains of chest pain and fainting during intense exercise. On examination, a systolic ejection murmur is heard that increases with standing. What is the most likely diagnosis?
115. Question: A 3-year-old child presents with a swollen, red, and tender The child has a fever and refuses to bear weight on the leg. What is the most likely diagnosis?
116. Question: Which of the following fine motor skills is typically expected of a 3-year-old child?
117. Question: A 5-year-old presents with a 3-month history of soiling his The child was successfully toilet trained at 3. What is the most likely diagnosis?
118. Question: A 6-year-old child presents with a loud, harsh, holosystolic murmur at the left lower sternal border. What is the most likely diagnosis?
119. Question: A 4-year-old child presents with a chronic cough, wheezing, and difficulty breathing, especially at On examination, you hear expiratory wheezing and observe the use of accessory muscles for breathing. What is the most likely diagnosis?
120. Question: The 16-year-old mother of a 2-month-old presents the infant, reporting that the child is very irritable and does not feed During physical examination, the child’s head drops back and the child exhibits sudden flexing of the extremities. As the flexing stops, the child cries uncontrollably. Funduscopic examination reveals retinal hemorrhages. Which of the following diagnostic tests should be ordered?
121. Question: Patients who present with agitation, confusion, tachycardia and hypertension, dilated pupils, loss of muscle coordination, twitching muscles, muscle rigidity, diaphoresis, and diarrhea should be worked up for which of the following conditions?
122. Question: An adult patient who was already taking Tramadol for back pain recently initiated Sertraline for new-onset The patient returns, complaining of feeling unwell. Which of the following signs would make the nurse practitioner suspect that the patient has developed serotonin syndrome?
123. Question: An adult G0P0 patient presents with reports of breast discharge for several The discharge is thin, milky, and non-odorous. The patient denies any pain, masses, or skin changes of either breast. She has a history of seizures and bipolar disorder and has had a recent normal MRI. She is taking divalproex (Depakote), risperidone (Risperdal), clonazepam (Klonopin), and conjugated estrogens (Premarin Vaginal Cream). Which medication should the nurse practitioner consider changing?
124. Question: Patients with altered mental state should be considered for all of the following potential causes except which of the following?
125. Question: Which of the following represent precipitating factors for excited delirium?
126. Question: A patient presents to the clinic for a 2-week follow-up after increase of escitalopram (Lexapro) to 20 mg oral daily for major depressive The patient reports taking the medication daily as prescribed but is concerned there has been no improvement. Which of the following is the nurse practitioner’s best course of action?
127. Question: Care of a patient with post-traumatic stress disorder may require the nurse practitioner to focus on discussing which of the following elements during the patient’s care?
128. Question: Care of a patient with post-traumatic stress disorder may require the nurse practitioner to focus on discussing which of the following elements during the patient’s care?
129. Question: An adult female was treated for postpartum depression with selective serotonin reuptake inhibitors (SSRIs) by another healthcare provider. The patient reports continuing lethargy and Before the dose of SSRIs is increased, it is most important to obtain:
130. Question: Which of the following need to be assessed when determining if a patient is a risk of self-harm or harm to others?
131. Question: Which of the following women is MOST at risk for developing breast cancer?
132. Question: A nurse practitioner examines a female patient with suspected trichomoniasis, which is a disease cause by:
133. Question: The drug of choice for treatment of gonorrhea is:
134. Question: A patient is 28 weeks pregnant and presents with a single episode of vaginal Prenatal progress is normal, and the patient denies pain, vaginal itching, or discharge. Which of the following is the most appropriate to determine a diagnosis?
135. Question: An adult smoker who is 10 weeks pregnant presents with blood-tinged greenish She reports a 1-week history of sore throat and cough. Temperature = 100 degrees F (37.8 degrees C), she is positive for submandibular lymphadenopathy, her throat is red, and a few scattered crackles are present. She has a history of penicillin allergy. The nurse practitioner should order:
136. Question: A 46-year-old female presents with a complaint of amenorrhea for 3 The first- line diagnostic workup is:
137. Question: An adult female 12 weeks gestation G1P0 presents to the OB clinic with lower quadrant abdominal pain, and cramping, spotting, and low back Vital signs are: BP = 80/50 mm Hg, P = 130, R = 30/min, and she is afebrile. What is the most likely diagnosis?
138. Question: Major complications of pelvic inflammatory disease (PID) include:
139. Question: Which of the following is most likely to cause intrauterine growth retardation?
140. Question: A female patient was sexually assaulted with the past 120 hours and is concerned about unwanted pregnancy. The correct prescription would be:
141. Question: A geriatric female presents with 48 hours of regional burning pain on the right side of the ribs. The nurse practitioner starts drug treatment with:
142. Question: A previously healthy patient is diagnosed with community-acquired pneumonia. Which of the following is a prognostic severity criterion that may indicate the need for referral for hospital admission and treatment?
143. Question: Your patient with a history of COPD is being evaluated in urgent care with respiratory distress. Which of the following interventions would NOT cause the patient to potentially develop worsening of respiratory acidosis?
144. Question: The following are side effects of albuterol use except which of the following?
145. Question: An adult presents for f/u regarding He has been waking up at night twice a week and using his albuterol three days of the week. The next best prescription management would be:
146. Question: A 55-year-old man with a history of smoking presents with a persistent cough and hemoptysis. A chest X-ray reveals a solitary lung What is the most appropriate next step?
147. Question: Patients with bullous lung disease are at risk of developing all the following except which barotrauma-related complication?
148. Question: An adult presents for a 3-month follow-up visit for intermittent asthma. The patient’s current treatment plant is albuterol (Ventolin HFA) as needed. The patient reports coughing, wheezing, and chest tightness that require inhaler use 3 days a The patient also reports nighttime coughing about once per week in the last month. What is the nurse practitioners BEST plan of care?
149. Question: A 25-year-old woman presents with a sudden onset of shortness of breath and pleuritic chest She has no significant past medical history and takes no medications. On physical examination, her heart rate is 110 beats per minute, respiratory rate is 24 breaths per minute, and oxygen saturation is 90% on room air. What is the most likely diagnosis?
150. Question: Your adult patient with asthma states she is unhappy you are unwilling to renew her prescription for her albuterol inhaler because it’s only been two weeks and it is completely used already. Which of the following statements made by the nurse practitioner best explains the rationale for this decision?